Systematic investigation into the phylogenetic origins of near-death experiences

Protocol for a systematic investigation into the phylogenetic origins of near-death experiences Costanza Peinkhofer 1,#, Charlotte Martial 2,#, Helena Cassol 2, Steven Laureys 2, Daniel Kondziella 3,4 1 Department of Psychiatry, Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark 2 Coma Science Group, GIGA Consciousness, University of Liège, Belgium 3Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark 4 Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark # contributing equally Corresponding author: Daniel Kondziella, MD, PhD, MSc, FEBN Department of Neurology Rigshospitalet, Copenhagen University Hospital DK-2100 Copenhagen daniel_kondziella@yahoo.com +45-3545-63688 Keywords: Death, death feigning, evolution, near-death experience, phylogenetics, survival, thanatosis 1. Background Near-death experiences (NDEs) are unique unexplained events occurring in situations as diverse as cardiac arrest, traffic accidents, physical assault, REM sleep intrusion into wakefulness, drug consumption, and many more (1–3). A convincing pathophysiological model is still lacking (4). However, given that NDEs have been preserved in humans for many centuries, the questions arise if NDEs may have an evolutionary benefit and if comparative biology may allow insights into the origin of NDEs (5–7). When attacked by a predator, as a last resort, animals may play dead to improve their chances for survival. (The best-known example is perhaps the opossum (8).) This phenomenon is known as thanatosis, a.k.a. death-feigning or tonic immobility (9). Thanatosis occurs in a large variety of taxa, including insects (10,11), reptiles (12), and mammals (13–15). In humans, it has been described as a defense mechanism happening during sexual assault (16,17). Thanatosis is an anti-predator strategy that is part of an innate defense cascade (18,19), being activated when fight or flight are no longer possible (5,20,21). It consists of sudden onset of immobility, with or without loss of tonic muscular activity, and unresponsiveness to external stimuli, but preserved awareness of the environment (21). Of note, this is akin to some forms of REM sleep intrusion into wakefulness in humans, namely lucid dreaming and cataplexy, that can occur in NDE (22). 2. Aims and hypotheses We hypothesize that NDEs originate from thanatosis and that thanatosis is phylogenetically persevered throughout the animal kingdom. Our aim is to establish a line of argumentation that NDE and thanatosis are heritable behavioral traits evolving under natural selection and serving the biological purpose of survival. 3. Methods We will collect data through the following 5 work packages: 1. Identifying a suitable cladogram from insects to the great apes, based on National Center for Biotechnology Information (NCBI) taxonomy and created using freely available, non-commercial software (phylot.biobyte.de), and performing a systematic literature review (see below) on reports of thanatosis in animals. Special emphasis will be placed on reports showing a survival benefit owing to thanatosis. Objective: To document the existence of thanatosis in animals at all important cladogram nodes. 2. Searching the Liège Coma Science Group NDE database for experiences related to physical assault, traffic accidents and similar encounters. Objective: To document the occurrence of NDE in humans under attack by “modern predators” such as sexual offenders or approaching cars. 3. Reaching out to NDE communities via Facebook, Instagram and Twitter, to inquiry about NDEs related to encounters with domestic or exotic animals (e.g. sharks, tigers), sexual assault, robbery, car accidents, etc. Objective: To document the occurrence of NDE in humans under attack by “modern” and animal predators. 4. Contacting suitable organizations that track encounters between humans and big animals including white sharks (Tarongo Zoo in Sidney, and similar institutions in South Africa, Florida, and California), African wildlife (e.g., Serengeti National Park) and tigers (e.g. the Nagarjunsagar-Srisailam Tiger Reserve in India), to inquire about possible NDEs in survivors of these encounters. Objective: To document the occurrence of NDE in humans under attack by animal predators. 5. Searching through testimonials of survivors of mass executions and similar atrocities during e.g. WWII, the war in Ex-Yugoslavia, and the Rwanda genocide, for possible instances of thanatosis and/or NDE that might have helped these people to survive those events. Testimonials will be searched for using Google, Google Scholar and Wikipedia; dedicated websites from relevant institutions such as the United States Holocaust Memoria Museum; Yad Vashem, The World Holocaust Remembrance Center; and Remembering Srebrenica; and a supervised literature search with the help of Copenhagen University Library. Objective: To document the occurrence of thanatosis in humans leading to a survival benefit. 3.1. Systematic literature review (Work package 1) A systematic review of the literature using a predefined search strategy will be performed. The aim is to identify at least one pertinent study for each cladogram node reporting thanatosis or tonic immobility in the animal kingdom. Types of studies: We will evaluate all cross-sectional or longitudinal, retrospective or prospective, observational clinical and research studies as well as interventional trials, case reports, and reviews reporting on thanatosis or tonic immobility in both animals and humans. We will include studies published in English, French, Italian, and listed in PubMed, Scopus, and Google Scholar. (Other language literature will be included only in case of that an English abstract and a reliable translation of the manuscript into English are available). Electronic literature search: We will search MEDLINE (PubMed), Scopus, and Google Scholar for relevant English, French, German, and Italian literature until the 31st October 2020. The literature search will be supervised by an information specialist and the search strategy will be developed in accordance with the clinical question. We will use the following search terms: “thanatosis”, “thanatomimesis”, “death-feigning”, “tonic immobility”, “apparent death”. Non-English literature, other than Italian, Germans and French, will be included only if an English abstract is available and a reliable translation of the manuscript into English possible. The references of relevant articles will be manually searched to identify additional articles. Further, papers will be cross-referenced using the ‘cited by’ function on PubMed. If necessary, personal communication with authors will be attempted via email or phone in order to obtain additional relevant data. The search strategies (including MeSH headings for searches in PubMed) will be saved and recorded in an appendix. Selection of studies: Titles will be reviewed first, followed by an evaluation of the abstracts with titles suggesting that a study might be of relevance. Eligible studies will be identified on the basis of their full text. At least one relevant study will be selected for each cladogram node and included in the article. Special emphasis will be placed on reports showing a survival benefit owing to thanatosis. We will use Mendeley Software to manage the large number of studies. 3.2. Statistics and protocol preregistration Whenever feasible, we will apply descriptive statistics. More advanced statistics and/or meta-analysis of data are not deemed appropriate because of this study’s observational and narrative methodology. We will preregister this protocol with the Center for Open Science (https://www.cos.io/initiatives/prereg). 4. Publication, authorship rules, funding and conflict of interests We aim to upload results on preprint servers and institutional websites, as appropriate, and publish the final manuscript in a peer-reviewed, PubMed-listed journal. Authorship will be defined according to Vancouver criteria. Specific funding is not available for this study, but the authors will list all other funding they have received during the period of the study. The authors declare no conflicts of interest. Bibliography 1. Charland-Verville V, Martial C, Cassol H, Laureys S. Near-death experiences: Actual considerations. Coma and Disorders of Consciousness: Second Edition. Springer International Publishing; 2017. 235–263 p. 2. Martial C, Cassol H, Laureys S, Gosseries O. Near-Death Experience as a Probe to Explore (Disconnected) Consciousness. Vol. 24, Trends in Cognitive Sciences. Elsevier Ltd; 2020. p. 173–83. 3. Martial C, Cassol H, Antonopoulos G, Charlier T, Heros J, Donneau A-F, et al. Temporality of features in near-death experience narratives. Front Hum Neurosci [Internet]. 2017 Jun 13 [cited 2019 Jan 24];11:311. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28659779 4. Peinkhofer C, Dreier JP, Kondziella D. Semiology and Mechanisms of Near-Death Experiences. 2019; 5. Kondziella D. The Neurology of Death and the Dying Brain : A Pictorial Essay. 2020;11(July):1–16. 6. Lake J. The near-death experience (NDE) as an inherited predisposition: Possible genetic, epigenetic, neural and symbolic mechanisms. Med Hypotheses. 2019;126:135–48. 7. Evrard R, Toutain C, Glazier JW, Maléfan P Le. The Energy of Despair: Do Near-Death Experiences Have an Evolutionary Value? Psychol Conscious Theory Res Pract. 2018; 8. Gabrielsen GW SE. Physiological responses associated with feigned death in the American opossum. 1985 Apr;123(4):393-8. doi: 10.1111/j.1748-1716.1985.tb07605.x. PMID: 3993399. Acta Physiol Scand. 1985;123(4):393–8. 9. Humphreys RK, Ruxton GD. A review of thanatosis ( death feigning ) as an anti-predator behaviour. 2018; 10. Kiyotake H, Matsumoto H, Nakayama S, Sakai M, Miyatake T, Ryuda M, et al. Gain of long tonic immobility behavioral trait causes the red flour bee

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